Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities
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Daniel Gabbai
Abstract
Background:
Different etiologies for recurrent pregnancy loss have been identified, among them are: anatomical, endocrine, genetic, chromosomal and thrombophilia pathologies.
Aims:
To assess medical and obstetric characteristics, and pregnancy outcomes, among women with uterine abnormalities and recurrent pregnancy loss (RPL). This study also aims to assess the impact of uterine anatomic surgical correction on pregnancy outcomes.
Methods:
A retrospective case control study of 313 patients with two or more consecutive pregnancy losses followed by a subsequent (index) pregnancy. Anatomic abnormalities were detected in 80 patients. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center. Out of 80 patients with uterine anatomic abnormalities, 19 underwent surgical correction, 32 did not and 29 had no clear record of surgical intervention, and thus were excluded from this study.
Results:
Women with anatomic abnormalities had a higher rate of previous cesarean section (18.8% vs. 8.6%, P=0.022), tended to have a lower number of previous live births (1.05 vs. 1.37, P=0.07), and a higher rate of preterm delivery (22.9% vs. 10%, P=0.037). Using multivariate logistic regression analysis, anatomic abnormality was identified as an independent risk factor for RPL in patients with previous cesarean section after controlling for place of residence, positive genetic/autoimmune/endocrine workup, and fertility problems (OR 7.22; 95% CI 1.17–44.54, P=0.03). Women suffering from anatomic abnormalities tended to have a higher rate of pregnancy loss compared to those without anatomic abnormalities (40% vs. 30.9%, P=0.2). The difference in pregnancy loss rate among women who underwent surgical correction compared to those who did not was not statistically significant.
Conclusion:
In patients with previous cesarean section, uterine abnormality is an independent risk factor for pregnancy loss. Surgical correction of uterine abnormalities among RPL patients might have the potential to improve live birth rate.
Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
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©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
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- Editorial
- Antenatal and prepregnancy care – prevention of perinatal morbidity and mortality
- Review article
- Fetal interventional procedures and surgeries: a practical approach
- Opinion paper
- Inverted pyramid of prenatal care – is it enough? Should it be – extended inverted pyramid of prenatal care?
- Research articles
- Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin
- Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities
- Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia
- Sonographic prediction of small and large for gestational age in breech-presenting fetuses
- Comparison of fetal weight distribution improved by paternal height by Spanish standard versus Intergrowth 21st standard
- Can early ultrasonography explain the lower miscarriage rates in twin as compared to singleton pregnancies following assisted reproduction?
- Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD
- Regular research articles
- Induction of labor in twin gestation: can we predict success?
- Low dose aspirin for preventing fetal growth restriction: a randomised trial
- Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies
- Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial
- Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy
- Fetal brain development in diabetic pregnancies and normal controls
- Body composition in preterm infants with intrauterine growth restriction: a cohort study
- Commentary
- Professionally responsible management of gynecologic cancer in pregnancy when clinical resources are unavoidably limited
- Letters to the Editor
- Erroneous conclusion due to mis-calculation of data: reply to Rai SE, Sidhu AK, Krishnan RJ. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis. J Perinat Med 2017
- Reply to: Letter to the Editor by Stritzke A and Shah PS. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis
- Congenital Zika syndrome in non-endemic regions
- Reply to: Congenital Zika syndrome in non-endemic regions: A neuroimaging pattern-based approach
Articles in the same Issue
- Frontmatter
- Editorial
- Antenatal and prepregnancy care – prevention of perinatal morbidity and mortality
- Review article
- Fetal interventional procedures and surgeries: a practical approach
- Opinion paper
- Inverted pyramid of prenatal care – is it enough? Should it be – extended inverted pyramid of prenatal care?
- Research articles
- Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin
- Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities
- Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia
- Sonographic prediction of small and large for gestational age in breech-presenting fetuses
- Comparison of fetal weight distribution improved by paternal height by Spanish standard versus Intergrowth 21st standard
- Can early ultrasonography explain the lower miscarriage rates in twin as compared to singleton pregnancies following assisted reproduction?
- Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD
- Regular research articles
- Induction of labor in twin gestation: can we predict success?
- Low dose aspirin for preventing fetal growth restriction: a randomised trial
- Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies
- Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial
- Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy
- Fetal brain development in diabetic pregnancies and normal controls
- Body composition in preterm infants with intrauterine growth restriction: a cohort study
- Commentary
- Professionally responsible management of gynecologic cancer in pregnancy when clinical resources are unavoidably limited
- Letters to the Editor
- Erroneous conclusion due to mis-calculation of data: reply to Rai SE, Sidhu AK, Krishnan RJ. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis. J Perinat Med 2017
- Reply to: Letter to the Editor by Stritzke A and Shah PS. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis
- Congenital Zika syndrome in non-endemic regions
- Reply to: Congenital Zika syndrome in non-endemic regions: A neuroimaging pattern-based approach
